GOSNELLS DOG OBEDIENCE CLUB MEMBERSHIP FORM

GOSNELLS OBEDIENCE DOG CLUB INC
MEMBERSHIP FORM
GOSNELLSOBEDIENCE DOG CLUB INC
PO Box 776 GOSNELLS, WA 6990 | Phone: 0413 349 903
Email: enquiries@gosnellsdogclub.asn.au
MEMBERSHIP NO
TYPE OF MEMBERSHIP

Membership type

	New	Renewal
Single
Family
Pension / Concession
Student
Country
Trainer

Renewals Only: Membership No on card
• If you have indicated a student or pension you will be required to produce the appropriate concession card for perusal by the membership officer.

• You will need to produce a vaccination certificate for your dog(s) for perusal by the membership officer

• Renewals will be sent by email unless otherwise requested. Please let us know if you require it to be posted to you.
DATE JOINED new members

MonthDayYear
Date
Owner Name

First NameLast Name
TELEPHONE
Address

POSTAL ADDRESS

Street Address Line 2

SUBURBState / Province

Postal / Zip Code
EMAIL
example@example.com
POSTCODE
DOG DETAILS
DOG NAME
BREED
SEX

MaleFemale
DOG DATE OF BIRTH

MonthDayYear
Date
If you have more than 2 dogs please list the other dogs here
DOG INFORMATION - BEHAVIOUR
Does Your dog have any behavioral issues we need to be aware of?

YesNo
Behaviour

SociableExitableQuietBoldConfidentEnthusiasticAnxiousBoisterousStubbornProtectiveAggressive to peopleReactive to other dogsOther
Is your dog

microchippedon any medicationregistered with your council
Dogs last vaccination date

MonthDayYear
Date
TRAINING
Have you done any training? If yes, where?

Dog clubPrivate classesHome
Type of training?

ObedienceAgilityRallyHerdingDWDOther
How would you describe the training

Reward basedMostly correctionsPhysical / assertiveOther
WHERE DID YOU HEAR ABOUT US?
FacebookNewspaperWord of mouthOther
The Gosnells Obedience Dog Club (Inc) wishes to advise all persons training on its training ground in the Lumen Christi College:
• Handlers are personally liable for their dogs at all times. If your dog bites someone, causes injury to another animal, or wanders onto the road adjacent to the training ground, the owner or handler is responsible in the event of any claim being made - not the club.
• In the event of injury to a person or another animal the owners will need to meet with the training coordinator prior to the dog coming back on the ground. This event may be raised with the committee.
• Members participating in training and events do so at their own risk, GODC is not liable should they injure themselves during training or an event.
• Photos taken of class activities may be used for club promotional purposes.

I HAVE READ, UNDERSTOOD AND AGREE TO THE CONDITIONS OF THE ABOVE DISCLAIMER, AND THE CLUB RULES AND AIMS.
Members Signature

Clear
Date

MonthDayYear
Date
Date

MonthDayYear
Date
Membership No
Signature

Clear
Receipt No
Date

MonthDayYear
Date
OFFICE USE ONLY
Concession Card Sighted ☐ | Vaccination Card Sighted ☐ | PAID: Cash ☐ Card ☐

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Membership No: Receipt No:

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Signature: Date:

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Gosnells Obedience Dog Club

Website: www.gosnellsdogclub.asn.au
Facebook: www.facebook.com/GosnellsObedienceDogClub
Facebook (group): www.facebook.com/groups/433412630143686/
Should be Empty:

GOSNELLS OBEDIENCE DOG CLUB INC

MEMBERSHIP FORM

TYPE OF MEMBERSHIP

DOG DETAILS

DOG INFORMATION - BEHAVIOUR

TRAINING

WHERE DID YOU HEAR ABOUT US?

OFFICE USE ONLY